Meningocele in the olfactory area in spontaneous CSF rhinorrhea

Introduction: Spontaneous leakage of cerebrospinal fluid from the nasal cavity due to a defect in the anterior, middle and posterior skull base is a condition associated with both difficult clinical diagnosis and challenges in preoperative localization and treatment.Material and methods: For a period of 19 years in the Clinic of Ear, Nose and Throat at the University Hospital “St. George” were diagnosed 11 cases of spontaneous rhinorrhea with the presence of meningocele in the area of the olfactory cleftResults: In 8 of the clinical cases, we administered intrathecal fluorescein 10% due to the inconclusive data from HRCT and MRI / Cisternography for bone and dural defect in the base area in a positive beta 2 transferrin test. We find that the olfactory cleft is common localization in spontaneous CSF rhinorrhea.Conclusion: The elective choice of diagnostic method with aimed examination for defectarachnoid dilatation in the area of lamina cribrosa, meningocele in the area of the olfactory cleft and those in the sphenoid sinus significantly improves the quality of surgical treatment (preservation of the olfactory area on one side, minimizing orbital and additional dural defects). The discussion in multidisciplinary teams provides significant opportunities for accurate and timely diagnosis of this type of“hidden” defects. ------------------------------------------------------------------------------ Въведение: Спонтанното изтичане на ликвор от носната кухина вследствие на дефект в областта на предна, средна и задна база на черепа е състояние, свързано както със затруднено клинично диагностициране, така и с предизвикателства в предоперативното локализиране и лечение.Материал и методи: За период от 19 години в Клиниката по уши нос и гърло в УМБАЛ „Свети Георги“ са диагностицирани 11 случаи на спонтанна риноликворея с наличие на менингоцеле в областта на олфакторната цепка.Резултати: При 8 от клиничните случаи сме приложили интратекално флуоресцеин 10% поради неубедителните данни от HRCT и МРТ/ цистернография за костен и дурален дефект в областта на базата при позитивен бета 2 трансферинов тест. Установяваме, че олфакторната зона е най-честата локализация при спонтанна риноликворея.Заключение: Елективният избор на метод за диагностика с насочено търсене на дефект-арахноидна дилатация в областта на ламина криброза, менингоцеле в областта на олфактоната цепка, както и такива в сфеноидалния синус значително подобрява качеството в оперативното лечение (запазване на олфакторна зона от едната страна, минимизиране орбитални и допълнителни дурални дефекти). Съвместното дискутиране в мултидисциплинарни екипи дава значителни възможности за акуратната и навременна диагностика на този тип „скрити“ дефекти

Modern approach for complex treatment of odontogenic maxillary sinusitis

Introduction: Odontogenic maxillary sinusitis is associated with diseases of the maxillary teeth. The close anatomical relationship of these teeth with the floor of the maxillary sinus leads to violation of the integrity of its mucosa and creates prerequisites for the infection to pass into the sinus cavity. Odontogenic maxillary sinusitis is characterized by dental complaints and the typical symptoms of all rhinosinusitis. There is lack of consensus in the literature on the algorithm of behaviour in these cases.Aim: To recommend a contemporary algorythm of management in patients with odontogenic maxillary sinuitis, which is consistent with both the established rules for the treatment of rhinosinusitis and the individual characteristics of each clinical case.Materials and methods: For the period 2001-2021, 157 patients were treated at St. George University Hospital, after extraction of an upper tooth (4-6) or with symptoms of nasal breathing difficulties and unilateral whitish secretion with an unpleasant odour. All of them had a history of dental intervention and CT data for changes in the osteomeatal complex or „foreign bodies“ in the maxillary sinus.Results: All patients were discharged on the third day after admission in improved general condition without complaints. No late postoperative complications were observed. In 8 of the patients with sinuscopy, after the control CT examination, performed a month later, a second intervention was necessary for the extraction of residual fungal material.Conclusion: The treatment of odontogenic maxillary sinusitis involves interdisciplinary approach of otorhinolaryngologists and dental specialists. However, modern understanding of the functioning of the nasal cavities and the development of pathological processes in them help us to build and present an adequate concept for diagnosis and therapeutic behavior

Surgical approach for borderline „giant“ osteoma in the frontal sinus. Clinical case. Literature review

Introduction: Osteomas are benign tumors, with slow growth and a long period of asymptomatic development. The paranasal sinuses are often involved, the most affected one being the frontal sinus, followed by the ethmoid, maxillary and sphenoid sinuses. Etiologically, theories of inflammatory, traumatic, genetic genesis should be introduced, but the issue still remains unclear. The diagnosis is very often accidental, when performing radiography or computed tomography (CT). Clinically manifested osteomas with headache, facial deformity, mucocele, intracranial complications are subject to timely surgical intervention. The choice of surgical approach depends on the size of the osteoma and the location, as well as on the professional and technical capabilities given the more specific requirements for the instrument.Materials and methods: We present a clinical case of a 28-year-old man with complaints of headache in the frontal facial area. An X-ray revealed an osteoma in the area of the left frontal sinus, involving more than 2/3 of its cavity. CT was performed and a discussion of the possibilities of endoscopic endonasal surgery, given the borderline „giant“ osteoma with a diagonal size of about 2.75 cm (> 3 cm). An endoscopic endonasal approach was applied.Results: Endoscopic endonasal surgery was performed. The chosen surgical approach was Draf 3 type frontotomy with osteoma extirpation. In early postoperative period– 5 days, there aren’t registreted complications. The patient was followed endoscopically in the second week, first month, sixth month. A month later, a control CT scan was performed with data on residuality on the anterior wall of the frontal sinus, without drainage disturbance. Clinically, the patient has no complaints. There are no late postoperative complications.Conclusion: Symptomatic osteomas of the paranasal sinuses require timely surgery. The choice of surgical approach (open with osteoplastic flap, endonasal or combined) depends on the anatomical location, the size of the tumor, as well as the experience of the surgeon and the technical capabilities of the hospital. Endoscopic endonasal surgery is popular, with highly valued capabilities over time, but in „giant“ osteomas it is debatable given the risk of residuality

Clinical aspects of satellite diseases and cricoarytenoid joint involvement. Arthritis of the cricoarytenoid joint. Clinical case.

Introduction: Laryngeal involvement in rheumatoid arthritis is a rarely mentioned complication in clinical practice. In the literature over the last 10 years, single articles on the subject have been published, presenting a small number of clinical cases. Cricoarytenoid arthritis is a life-threatening condition requiring timely anesthesia and otorhinolaryngological intervention, where the tracheostomy has an important therapeutic place.Aim: With the presentation of our clinical case we aim to expand the knowledge about systemic diseases and their possible acute manifestation in otorhinolaryngological practice. Materials and methods: We present a clinical case of patient M.S., 63 years old, female, with a long medical history of rheumatoid arthritis. She was admitted to the clinic with a tracheostomy cannula placed for acute laryngeal dyspnea. Physical examination with a fibrolaryngoscope revealed bilateral paresis of the vocal folds, in a medial position, without phonatory and respiratory activity. Computer tomography of the neck, chest, with a focus on the mediastinum – without clinical data on tumor processes. Laboratory tests reveal a repeatedly elevated rheumatoid factor.Results: MRI revealed a collapse of the larynx, with pronounced fatty degeneration of the thyroarytenoid and cricoarytenoid muscles. The patient was referred to a rheumatologist to control the chronic exacerbation process, with a definitive tracheostomy cannula.Conclusion: Pathological changes in the cricoarytenoid joint in patients with rheumatoid arthritis, as well as scleroderma, lupus, Felty’s syndrome, Tiez syndrome and other systemic diseases, are a common finding, although diagnosed in the past at autopsy. It can be acute, subacute and chronic, but in otorhinolaryngological practice it occupies an important clinical place in emergencies